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Better tobacco control essential to prevent high toll of cardiovascular disease in Africa

September is Heart Awareness Month, culminating on World Heart Day (WHD) on 29 September. Protect our Next, a coalition of health organisations supporting better tobacco control, is shining a spotlight on tobacco consumption as a key risk factor for cardiovascular disease (CVD) and the tobacco control measures in South Africa that could help prevent unnecessary CVD and other deaths.

According to the Heart and Stroke Foundation South Africa (HSFSA), heart disease and strokes have the second highest mortality rate in South Africa, after TB, HIV and AIDS. CVDs are responsible for one in five deaths, with over 82 000 lives lost annually.

Every hour in South Africa: 5 people have heart attacks, 10 people have strokes and of those events, 10 people will die. Yet, the triggers that give us our high cumulative risk score for CVDs, including tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol, are entirely preventable,” says Professor Pamela Naidoo, CEO of HSFSA and President of the African Heart Network. “Smokers are 2 to 4 times more likely to get heart disease than non-smokers. The younger you start, the higher your risk. That is why we are collaborating with like-minded partner organisations including the National Council Against Smoking, the Cancer Association of South Africa and the South African Medical Research Council to push Parliament to pass the Control of Tobacco and Electronic Delivery Systems Bill, which will strengthen control and make public areas 100% smoke-free.”

Speaking at a webinar to highlight the need for strong tobacco control, Professor Fastone Goma, President of the Zambia Heart and Stroke Foundation and Treasurer of the African Heart Network, said, “Tobacco is a global agent of death. It is a growing epidemic, and it is an economic threat. Tobacco more than doubles your risk of CVD and in the African region, CVD is a major issue. In Africa, we've already lost more than two Presidents to CVD, related to tobacco use. At the base of change is legislation. Communities must demonise tobacco use and health workers must have the resources to help those who are already addicted.” He called for stringent legislation, saying, “Even if you smoke one cigarette a day, your risk is 50% that of the risk of heavy smokers. We must go for zero tolerance. We can reduce risk factors by a large margin with effective tobacco control. This is even more urgent in the time of the pandemic, as Covid-19 should not find lungs that are primed by smoking.”

Prof Goma highlighted tobacco use concerns in Zambia, particularly the increasing use among young women. “In Zambia, 25% of girls are now smoking. This means we can expect the current smoking rates among women to be much higher in the future as these girls grow up. This continued introduction to children and young people makes tobacco control very necessary. No child born after 2010 should ever start smoking. We have the opportunity to achieve this – before the next generation is hooked. Let’s make a change so that the next generation is one that is healthier than before. We need to advocate for Mother Africa.”

In Sub-Saharan Africa, all countries except Malawi are signatories to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). “The FCTC provides clear guidelines to be implemented and within five years of signing up the government should be fully compliant to the FCTC. The World Health Assembly has highlighted that we need a whole of government approach to tobacco control. As with COVID-19, it is necessary for all departments to focus first on health, balancing this with other aspects,” says Prof Goma.

Public health policy and development consultant Zanele Mthembu highlighted that this all-of-government approach, as well as a groundswell of citizen-led support and multisectoral partnerships, is essential to progress tobacco-control in South Africa. “While South Africa initially led the African continent in tobacco control with measures that reduced smoking prevalence from 33% in the 90s to 18% by late 2000, the legislation that will bring us in line with FCTC commitments is still waiting to be processed. 75% of the existing Act has been amended, giving rise to the new Control of Tobacco Products and Electronic Delivery Systems Bill, 2018. Once passed into law, the Bill will repeal the existing Act. We must be fearless and persistent in getting this Bill passed to protect our nation’s health.”

Savera Kalideen, Executive Director of the National Council Against Smoking (NCAS), says the five key changes in the new Bill are introducing 100% smoke-free indoor areas; the regulation of e-cigarettes; the requirement for plain or standardised packaging and pictorial health warnings; banning advertising at tills; and eliminating cigarette vending machines. “To prevent the crippling health impact of smoking and reduce South Africa’s high incidence of NCDs, including CVD, that deplete our health budget, we must make it harder to smoke cigarettes, e-cigarettes or vape products, hookah pipes and other related tobacco products. This will protect everyone from damaging second-hand smoke, and curtail the tobacco industry’s ability to reach a new generation of smokers through misleading advertising.

Professor Naidoo says the Heart and Stroke Foundation, working with partner organisations including NCAS, CANSA and SAMRC, will not rest until the bill becomes law. “We are determined to drive awareness of the need to urgently pass the Tobacco Bill as well as educate South Africans, especially the youth, about the devastating impact smoking has on your cardiovascular health.

Stopping smoking is one of the best things you can do for your heart and health. It’s never too late to stop because there are almost immediate benefits; and if you continue to stay away from smoking, over time your risk of heart disease and stroke can fall to one that is almost equal to that of a non-smoker. e-cigarettes or vape products are just as addictive as tobacco smoking and can cause significant harm to the cardiovascular system, and also increase risks for lung cancer. People who smoke or use e-cigarettes or vape products are also more susceptible to more severe cases of Covid-19, a serious consideration in the current environment. We urge all South Africans to use their hearts to make healthier choices and prevent heart disease.”



· Professor Pamela Naidoo, CEO, Heart and Stroke Foundation of South Africa

· Professor Fastone Goma, President of the Zambia Heart and Stroke Foundation

· Savera Kalideen, Executive Director of the  National Council Against Smoking

· Zanele Mthembu, Public Health Policy and Development Consultant

· Dr. Sharon Nyatsanza, Project & Communications Manager, NCAS

· Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and other Drug Research Unit, South African Medical Research Council

· Lorraine Govender, National Advocacy Co-Ordinator, CANSA


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Tamaryn Brown

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